iSwallow: Maximizing technology to improve compliance
in dysphagia therapy
The University of California, Davis
Disclosure
•
I/UC Davis have no financial interest in this product
•
The “model” for the video clips did not have hair and
make up “people”.
2007 Time Magazine’s
Invention of the YEar
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Over 45,000,000 sold
between October 2007 and December 2009
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Over 1,000,000,000 Apps Downloaded
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Match Made in heaven
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Smartphones will transform Health
Industry
•
•
•
•
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Telemedicine
Virtual visits will reduce ER
visits
Patients can monitor their
own disease
Monitor weight, glucose,
blood pressure, serum
chemistry, mental health
Can be used as microscopes
and stethescopes
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Why iSwallow
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Dysphagia is prevalent
•
16.5 million Americans in
2010
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Most common symptom
following CVA
•
IN 59% after XRT for HNCA
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Why iSwallow
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Access to care is a problem
•
Aging population presents a
growing number of patients in
need of services
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Some data suggest an SLP
shortage
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Why iSwallow
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Dysphagia exercise works
•
Can prevent disability and
dysfunction in people
undergoing ChemoRT
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Can assist as a “starting point”
for those intolerant of saliva
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Why iSwallow
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Compliance is a major
hurdle to successful
therapy
•
Traditional swallowing
instructions are on paper
somewhere in the
house?
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Compliance with SLP
Dietary Recommendations
70
64
63
60
52
50
44
40
30
18
20
10
0
Stroke Ward
Geriatric
Ward
Medicine
Ward
Surgical
Ward
Rosenvinge SK, Starke ID. Improving care for patients with dysphagia. Age Ageing. 2005 Nov;34(6):587-93.
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Overall
Shaker Exercise
Isometric
70
70
60
50
Isokinetic
50
40
30
20
10
0
Attain Exercise Goal
Easterling et al. Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise. Dysphagia. Volume 20, Number 2, 133-138, DOI: 10.1007/s00455-005-0004-2.
Shaker Exercise
Easterling et al. Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise. Dysphagia. Volume 20, Number 2, 133-138, DOI: 10.1007/s00455-005-0004-2.
iSwallow-what
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Adjunct to therapy
•
Used under the
supervision of a clinician
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Compatible with iPad,
iPod2, iPhone (not Mac
computer)
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it is
iSwallow-what
•
A blanket set of OM or
swallowing ex given to
each patient
•
To be used in place of
functional swallowing
therapy
•
To be used without
periodic re-assessment
and adjustments
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it is not
iSwallow
•
Primary Goals
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Improve access to care
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Enhance dysphagia
education
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Improve exercise
compliance
-
Improve exercise
technique
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Getting Started
[email protected]
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Setup patient exercises
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Click on the Exercise
Setup tab to setup the
personalized exercise
program for your patient.
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Choose from the exercise
menu
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Choose the exercises
from the menu that you
want the patient to
perform.
In this example lets
choose the Massako
Maneuver. Click on the
Massako Maneuver tab to
turn on the exercise.
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Enable the exercise
•
Click the ON button to
enable this exercise
and then click the Next
tab to continue.
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Enter the number of repetitions
•
•
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Enter the number of
repetitions that you
want the patient to
perform the exercise.
The default number of
repetitions is 3.
Click the Save tab to
continue.
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Add the Time
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•
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Add the time that you
would like the patient to
perform the exercise.
Click on the Add Time
tab.
In this example, lets
choose 8am, 12pm,
4pm, and 8pm.
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Choose the 1st time
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Scroll the time to
800am and then click
the Save tab.
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Add the 2nd time
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Add the 2nd time that
you would like the
patient to perform the
exercise.
Click on the Add Time
tab.
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The Exercise Menu
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You will see the
iSwallow Exercise
screen showing the
exercises that your
clinician has
prescribed for you.
The exercises that are
overdue have a red
bar next to them. The
exercises that are
scheduled, but not yet
due have a green bar
next to them
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QuickTime™ and a
DV/DVCPRO - NTSC decompressor
are needed to see this picture.
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Case studies/sample exercise
protocol
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74 yo man with h/o BOT CA, 10
years ago treated primarily with
XRT. Total oral eater.
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Recent hospital admission with
pneumonia, determined to be
aspiration PNA
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Dynamic Swallow Study
findings included reduced
pharyngeal constriction,
reduced PES opening, reduced
hyolaryngeal excursion
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
Choose the Exercises from the exercise
menu
Theme: Swallow for Life!
Case studies/sample exercise
protocol
• 52 yo female laryngeal
transplant patient
•
Bilateral tvf paralysis,
closed position with
trach, PEG tube
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Intolerant of secretions,
periodically
expectorates secretions,
by occluding trach or
suctioning through trach,
unable to tolerate
QuickTime™ and a
H.264 decompressor
are needed to see this picture.
Choose the Exercises from the exercise
menu
Case studies/sample exercise
protocol
•
68 yo man with h/o C-spine + injury, s/p fusion
and instrumentation
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Trach, PEG tube dependent for 6 months
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Periodically expectorates secretions, tolerates
speaking valve 3x/day for 30 min-1hr
Theme: Your Tongue is the Super Hero!
XXXXX
QuickTime™ and a
decompressor
are needed to see this picture.
Mr. Snickers
Case studies/sample exercise
protocol
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Dynamic Swallowing Study findings included:
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Gross silent aspiration of small amounts 1cc, 3cc of
thick and thin liquids both during and after the
swallow, poor pharyngeal constriction
Choose the Exercises from the exercise
menu
Theme: Swallow Swallow Swallow!
or No Snickers for YOU!
Summary
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Smartphones will transform
the health industry
•
Compliance is a problem
•
Shortage of clinicians
•
iSwallow may help bridge
the gap and improve
outcomes?
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